Fertility Preservation Before Cancer Treatment

Why Fertility Preservation Matters

Cancer survival rates have improved dramatically. Today, many cancer patients — particularly young adults — will survive their disease and go on to desire families. However, many cancer treatments (chemotherapy, radiation, surgery) can permanently damage reproductive function.

Fertility preservation before cancer treatment offers patients the possibility of biological parenthood after recovery. At PTA Fertility Centre, we prioritise oncology referrals and can often initiate treatment within days of first contact.

Which Treatments Affect Fertility?

High Risk (>80% chance of permanent infertility)

Alkylating agents: Cyclophosphamide (high dose), Busulfan, Melphalan
Total body irradiation
Pelvic radiation (ovarian dose >6 Gy in adults)
Bilateral oophorectomy or orchiectomy

Moderate Risk (40-60%)

Cyclophosphamide (standard dose)
Cisplatin/Carboplatin combinations
Doxorubicin/Adriamycin protocols
Abdominal/pelvic radiation (lower doses)

Lower Risk (<20%)

Methotrexate, 5-FU, Vincristine
Taxanes (Paclitaxel, Docetaxel)
Targeted therapies (Herceptin, Tamoxifen)

Important: Risk is cumulative and influenced by patient age, baseline ovarian reserve, and total drug dose. Younger patients are more resilient but not immune to damage.

Fertility Preservation Options for Women

Egg (Oocyte) Freezing

The most established method. Ovarian stimulation (10-14 days) followed by egg retrieval and vitrification. Requires approximately 2 weeks from start to completion.

Timing: Can start at any point in the menstrual cycle (random-start protocols available for urgent cases)
Delay to cancer treatment: Approximately 2 weeks
Success: Survival rate >90% upon thawing; future pregnancy rates depend on age at freezing and number of eggs stored
Suitable for: Post-pubertal women, no partner required

Embryo Freezing

Same as egg freezing but eggs are fertilised with partner/donor sperm before freezing. Slightly higher success rates than egg freezing as embryos are more robust.

Requirements: Partner or donor sperm
Advantage: Proven technology with decades of data
Consideration: Shared ownership of embryos (relevant if relationship status changes)

Ovarian Tissue Freezing

Surgical removal and freezing of ovarian cortex tissue containing primordial follicles. The tissue can later be transplanted back to restore both fertility and hormonal function.

Advantage: No delay to cancer treatment (surgery can often be combined with port insertion); suitable for pre-pubertal girls
Status: No longer considered experimental; live births reported worldwide
Limitation: Requires surgery; theoretical risk of re-introducing cancer cells (for blood cancers)

GnRH Agonist (Ovarian Suppression)

Monthly injections (Lucrin/Zoladex) during chemotherapy to suppress ovarian function, potentially protecting follicles from damage.

Evidence: Some evidence of benefit, particularly for breast cancer patients
Limitation: Not a substitute for egg/embryo freezing — should be used as an adjunct, not sole strategy

Fertility Preservation for Men

Sperm Freezing (Cryopreservation)

Simple, non-invasive, and can be done in a single visit. Multiple samples can be stored for increased security.

Timing: Ideally before any chemotherapy (even one cycle can damage sperm DNA)
Process: Semen sample collected by masturbation, processed, and frozen
Delay: None — can be done the same day as oncology consultation
Success: Frozen sperm can be used for IUI or IVF/ICSI with good outcomes

Testicular Sperm Extraction (TESE)

For men unable to ejaculate or with very low sperm counts due to disease, surgical extraction from testicular tissue is possible.

Timing and Urgency

The window between cancer diagnosis and treatment start is often narrow. Key principles:

For men: Sperm can be frozen the same day — no delay to cancer treatment
For women: Egg freezing requires ~2 weeks. Random-start protocols allow treatment to begin at any cycle day, minimising delay
Oncology coordination: Most oncologists support a 2-week delay for fertility preservation when safe. We communicate directly with your oncology team
Urgent referral pathway: At PTA Fertility Centre, oncology fertility referrals are seen within 24-48 hours. Call +27 12 998 8854 and inform reception that this is an oncology fertility preservation referral

For Referring Oncologists

We welcome referrals from oncology teams across South Africa. Our oncofertility pathway includes:

Same-day or next-day consultation for urgent cases
Direct communication with the treating oncology team
Random-start stimulation protocols to minimise delay
GnRH antagonist protocols safe for hormone-sensitive cancers
Letrozole co-treatment for breast cancer patients requiring stimulation
Coordination with surgical teams for ovarian tissue cryopreservation

Referral contact: +27 12 998 8854 | info@ptafertility.co.za (mark as "Oncofertility — Urgent")

FAQ

Oncofertility FAQ

Will fertility preservation delay my cancer treatment?

Sperm freezing causes no delay. Egg freezing requires approximately 2 weeks. Most oncologists consider this acceptable when the cancer diagnosis is not immediately life-threatening. Random-start protocols minimise timing.

Is ovarian stimulation safe with hormone-sensitive cancers?

Yes, when appropriate protocols are used. For breast cancer, we use letrozole co-treatment to keep estrogen levels low during stimulation. Evidence shows no adverse oncological outcomes.

Does medical aid cover fertility preservation for cancer patients?

Some medical aids provide partial coverage for medically indicated fertility preservation. We recommend contacting your scheme directly and can provide motivation letters.

Can I use my frozen eggs/embryos years later?

Yes, vitrified material can be stored indefinitely. Many cancer survivors successfully use frozen eggs/embryos 5-10+ years after preservation.

What if I can only afford one cycle?

One cycle of egg freezing is better than none. We aim to optimise each cycle for maximum egg yield. For patients with financial constraints, we discuss options transparently.

My child has cancer — can fertility be preserved?

For post-pubertal adolescents, egg/sperm freezing is possible. For pre-pubertal children, ovarian or testicular tissue freezing is the main option. This requires coordination between paediatric oncology, surgery, and our team.